Burr NE, Gracie DJ, Black CJ, et al. - Findings revealed that upadacitinib 45 mg once daily for moderate to severe ulcerative colitis ranked first for clinical remission in all patients, patients naïve to anti-TNF (tumour necrosis factor)-α drugs and those previously exposed. For endoscopic improvement, infliximab 10 mg/kg ranked first. Safety and good tolerability of most drugs was evident.

• This systematic review and network meta-analysis was conducted to assess relative efficacy and safety of biological therapies and small molecules in moderate to severely active ulcerative colitis.

• Analysis of 28 trials (12 504 patients) revealed that based on failure to achieve clinical remission, upadacitinib 45 mg once daily ranked first compared to placebo (relative risk RR 0.73), with infliximab 5 mg/kg and 10 mg/kg second and third, respectively.

• As far as clinical remission was concerned, upadacitinib ranked first in both cases naïve to anti-TNF-α drugs (RR 0.69) and previously exposed (RR 0.78).

• Relative to all other drugs evaluated, upadacitinib was better.

• Infliximab 10 mg/kg ranked first based on failure to achieve endoscopic improvement (RR 0.61), with upadacitinib 45 mg once daily, second, and infliximab 5 mg/kg third.

• Adverse events were more likely to occur with upadacitinib, but serious adverse events were no more frequent, and withdrawals because of adverse events were significantly lower relative to placebo.

• Tofacitinib was associated with significantly greater likelihood of infections than placebo (RR 1.41).